National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services (NAMCS CLAS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att G - IRB Approval Letter.docx	Supplementary Document	Uploaded 2016-05-23	Available
Att F -Letters 061616.docx	Supplementary Document	Uploaded 2016-06-16	Available
Att E - Consultants.docx	Supplementary Document	Uploaded 2016-05-23	Available
Att B - 60dy Federal Register Notice.pdf	Supplementary Document	Uploaded 2016-05-23	Available
Att A - Public Health Service Act.docx	Supplementary Document	Uploaded 2016-05-23	Available
2016 NAMCS CLAS OMB SS-B 061516.docx	Supporting Statement B	Uploaded 2016-06-16	Available
2016 NAMCS CLAS OMB SS-A 061516.docx	Supporting Statement A	Uploaded 2016-06-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221652	Att D_Phone Script	Other-WORD	New
221651	Att C_NAMCS CLAS Questionnaire	Other-WORD	New

ICR Details

OMB Control No: 0920-1119	ICR Reference No: 201605-0920-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15BCU
Title: National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services (NAMCS CLAS)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/27/2016
	Date Received in OIRA: 05/27/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	12 Months From Approved
Responses	3,312	0	0
Time Burden (Hours)	676	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The general purpose of this study is to describe cultural and linguistic competency and the provision of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) among office-based physicians regionally and nationally in the United States.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
   US Code: 42 USC 242M(d) Name of Law: Public Health Service Act
   PL: Pub.L. 107 - 347 Title 5 Name of Law: Confidential Information Protection and Statistical Efficiency Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 52291	08/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 32758	05/24/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Att C_NAMCS CLAS Questionnaire
Att D_Phone Script

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,312	0	0	3,312	0	0
Annual Time Burden (Hours)	676	0	0	676	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $300,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/27/2016

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